preferences for hiv testing services and hiv self testing distribution among migrant CORD-Papers-2022-06-02 (Version 1)

Title: Preferences for HIV Testing Services and HIV Self-Testing Distribution Among Migrant Gay Bisexual and Other Men Who Have Sex With Men in Australia
Abstract: BACKGROUND: In Australia undiagnosed HIV rates are much higher among migrant gay bisexual or other men who have sex with men (GBMSM) than Australian-born GBMSM. HIV self-testing is a promising tool to overcome barriers to HIV testing and improve HIV testing uptake among migrant GBMSM. We compared the preferences for HIV testing services including HIV self-testing among migrant and Australian-born GBMSM. METHODS: Preferences were assessed via two discrete choice experiments (DCEs). Participants were recruited between December 2017 and January 2018 using online and offline advertising and randomly assigned to complete one of two online DCE surveys. Migrant GBMSM were classified as being born in a country with a reciprocal healthcare agreement (RHCA) with Australia (providing free or subsided health care) or not. Latent class analysis and mixed logit models were used to explore heterogeneity in preferences. FINDINGS: We recruited 1606 GBMSM including 583 migrant men of whom 419 (72%) were born in non-RHCA countries. Most participants preferred a free or cheap oral test with higher accuracy and a shorter window period to facilitate early detection of infections. Cost was more important for men born in non-RHCA countries than for men from RHCA countries or Australia. All groups preferred accessing kits through online distributers or off the shelf purchasing from pharmacies. Men born in RHCA countries least preferred accessing HIV self-testing kits from a medical clinic while more than half of men from non-RHCA countries most preferred sourcing kits from a clinic. Sex-on-premises venues were the least preferred location to access test kits among all groups. In addition two latent class analyses explored heterogeneity in preferences among men from non-RHCA countries and we found four latent classes for HIV testing services and two latent classes for HIVST distribution. INTERPRETATION: Our findings emphasise the need for high-performing and low-cost HIV self-testing kits that are accessible from a variety of distribution points as a component of Australia's HIV response especially for those who do not have access to free or subsidised health care in Australia.
Published: 2022-04-19
Journal: Front Med (Lausanne)
DOI: 10.3389/fmed.2022.839479
DOI_URL: http://doi.org/10.3389/fmed.2022.839479
Author Name: Zhang Ye
Author link: https://covid19-data.nist.gov/pid/rest/local/author/zhang_ye
Author Name: Wiseman Virginia
Author link: https://covid19-data.nist.gov/pid/rest/local/author/wiseman_virginia
Author Name: Applegate Tanya L
Author link: https://covid19-data.nist.gov/pid/rest/local/author/applegate_tanya_l
Author Name: Lourenco Richard De Abreu
Author link: https://covid19-data.nist.gov/pid/rest/local/author/lourenco_richard_de_abreu
Author Name: Street Deborah J
Author link: https://covid19-data.nist.gov/pid/rest/local/author/street_deborah_j
Author Name: Smith Kirsty
Author link: https://covid19-data.nist.gov/pid/rest/local/author/smith_kirsty
Author Name: Jamil Muhammad S
Author link: https://covid19-data.nist.gov/pid/rest/local/author/jamil_muhammad_s
Author Name: Terris Prestholt Fern
Author link: https://covid19-data.nist.gov/pid/rest/local/author/terris_prestholt_fern
Author Name: Fairley Christopher K
Author link: https://covid19-data.nist.gov/pid/rest/local/author/fairley_christopher_k
Author Name: McNulty Anna
Author link: https://covid19-data.nist.gov/pid/rest/local/author/mcnulty_anna
Author Name: Hynes Adam
Author link: https://covid19-data.nist.gov/pid/rest/local/author/hynes_adam
Author Name: Johnson Karl
Author link: https://covid19-data.nist.gov/pid/rest/local/author/johnson_karl
Author Name: Chow Eric P F
Author link: https://covid19-data.nist.gov/pid/rest/local/author/chow_eric_p_f
Author Name: Bavinton Benjamin R
Author link: https://covid19-data.nist.gov/pid/rest/local/author/bavinton_benjamin_r
Author Name: Grulich Andrew
Author link: https://covid19-data.nist.gov/pid/rest/local/author/grulich_andrew
Author Name: Stoove Mark
Author link: https://covid19-data.nist.gov/pid/rest/local/author/stoove_mark
Author Name: Holt Martin
Author link: https://covid19-data.nist.gov/pid/rest/local/author/holt_martin
Author Name: Kaldor John
Author link: https://covid19-data.nist.gov/pid/rest/local/author/kaldor_john
Author Name: Guy Rebecca
Author link: https://covid19-data.nist.gov/pid/rest/local/author/guy_rebecca
Author Name: Ong Jason J
Author link: https://covid19-data.nist.gov/pid/rest/local/author/ong_jason_j
sha: 4746020850eb2cf47585525dff50ccb9fe7f2dcc
license: cc-by
license_url: https://creativecommons.org/licenses/by/4.0/
source_x: Medline; PMC
source_x_url: https://www.medline.com/https://www.ncbi.nlm.nih.gov/pubmed/
pubmed_id: 35514755
pubmed_id_url: https://www.ncbi.nlm.nih.gov/pubmed/35514755
pmcid: PMC9063480
pmcid_url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9063480
url: https://www.ncbi.nlm.nih.gov/pubmed/35514755/ https://doi.org/10.3389/fmed.2022.839479
has_full_text: TRUE
Keywords Extracted from Text Content: people RG −0.26 −0.59 oral Thorne Harbour HIVST Facebook participants Medicare-subsidised sex-on-premises-venues Southeast Asia Australian-born GNT1193955 reduced-cost EC 1,606 men DCE-Test Human DCE hepatitis B virus GNT1172873 GBMSM anal men blood CF GNT1172900 KS self-tester saliva Figure 2 Supplementary Figures 1, migrants COVID-19 FT-P purchased sex-on-premises Thorne Harbour Health. participants https://www.frontiersin.org/articles/10.3389/fmed
Extracted Text Content in Record: First 5000 Characters:Nearly one in 30 people in the world live in a country other than their place of birth (1) . The focus on migrant health has been growing in recent years, with increasing recognition that the multi-faceted and heterogeneous nature of health risks, including those related to infectious disease prevention and control, can occur throughout the migration process (2) . However, limited availability of quality data, and in some cases, access to publicly subsidised healthcare hamper efforts to address the health needs of migrants (3) . Over a quarter of people living in Australia (29.7%) were born overseas (4) . In the early 2010s, migration-related HIV cases were predominantly diagnosed in people from sub-Saharan Africa (SSA), who acquired HIV before arriving in Australia (5) . More recently, there has been an increase in the number of new HIV diagnoses in Australia among gay, bisexual or other men who have sex with men (GBMSM) from Asia (6) . Migrants living in high-income countries are reported to have a lower self-perceived risk of HIV infection, language barriers, and concerns with confidentiality and privacy (7) (8) (9) (10) . Moreover, migrant GBMSM may face additional cultural and healthcare system barriers such as unfamiliarity with the local health system, distrust of health providers, and privacy concern, further hindering their access to HIV testing in conventional settings (11) (12) (13) . Between 2014 and 2019, HIV diagnoses among Australian-born GBMSM declined by 44%, which likely occurred due to improved coverage of HIV testing and treatment, and implementation of PrEP across Australia (14) . However, this success was offset by increased diagnoses among people born in other countries resulting in a relatively stable number of annual diagnoses overall (15) . Surveillance data from 2018 suggest that migrant GBMSM in Australia are three times more likely to be undiagnosed for HIV and three times more likely to be diagnosed late than Australian-born GBMSM (14) . Delays in testing lead to delayed treatment (16) , and untreated HIV infections can disproportionately contribute to HIV transmissions (17) (18) (19) . Together, this evidence underscores the urgent need to develop a better understanding of the needs of migrant GBMSM and improve access to earlier HIV testing, diagnosis, linkage to care, and bolster targeted prevention strategies. Medicare, Australia's universal health care scheme, is available to all Australian citizens and permanent residents. Medicare also covers temporary migrants from ten countries in Europe and New Zealand through reciprocal healthcare agreements (RHCA) (20) . With access to Medicare, migrants from RHCA countries have full access to free HIV testing. In comparison, migrants from non-RHCA countries can access free testing through public-funded programmes that are unevenly distributed across Australia or private insurance, which may require reimbursable upfront payments (21, 22) . Previous studies found that migrants ineligible for subsidised healthcare through RHCA were more likely to be diagnosed with HIV later than those born in Australia or countries covered by the RHCA agreement (23, 24) . In addition, studies on HIV and hepatitis B virus care in Australia have demonstrated that the issue of ineligibility for subsidised healthcare places additional psychological and financial pressure on migrants (25, 26) . HIV self-testing (HIVST) enables people to test for HIV conveniently and privately and is a promising tool to improve HIV testing uptake among migrant GBMSM (27, 28) . Studies from several countries have confirmed that access to HIVST kits increases HIV testing uptake and frequency among GBMSM (29) (30) (31) (32) . More recently, HIVST kits have been successfully implemented in several countries to test underserved populations during the COVID-19 pandemic (33) (34) (35) . To initiate or scale-up HIVST among GBMSM, various approaches to distribute HIVST kits have been evaluated globally, including through home delivery, pharmacies, vending machines, online purchasing, sexual or social networks, or social enterprise health campaignsall of which have shown favourable outcomes (36) (37) (38) . However, globally, little is known about the preferences of migrant GBMSM for accessing HIVST through these different channels. Discrete choice experiments (DCEs) are a methodology to understand user preferences for goods and services that are not yet widely available in the market (39) . Within a DCE, individuals are asked to state their preference between different goods or services on offer, with each of the goods or services described by their underlying characteristics or attributes (40) . Data from DCEs can be used to identify the trade-offs that individuals are willing to make between the attributes describing a good or service (41) . This method has been widely employed to quantitatively estimate user and provider preferences towards HIV testing services in various settings
Keywords Extracted from PMC Text: anal EC Figure 4 participants saliva sex-on-premises Facebook oral GNT1193955 men GBMSM people hepatitis B virus −0.26 KS GNT1172900 DCE sex-on-premises-venues blood Southeast Asia Figure 2 HIVST Thorne Harbour GNT1172873 DCE-Test FT-P Medicare-subsidised COVID-19 reduced-cost Australian-born purchased CF 33–35 Human " Supplementary Figures 1, migrants −0.59 self-tester RG
Extracted PMC Text Content in Record: First 5000 Characters:Nearly one in 30 people in the world live in a country other than their place of birth (1). The focus on migrant health has been growing in recent years, with increasing recognition that the multi-faceted and heterogeneous nature of health risks, including those related to infectious disease prevention and control, can occur throughout the migration process (2). However, limited availability of quality data, and in some cases, access to publicly subsidised healthcare hamper efforts to address the health needs of migrants (3). Over a quarter of people living in Australia (29.7%) were born overseas (4). In the early 2010s, migration-related HIV cases were predominantly diagnosed in people from sub-Saharan Africa (SSA), who acquired HIV before arriving in Australia (5). More recently, there has been an increase in the number of new HIV diagnoses in Australia among gay, bisexual or other men who have sex with men (GBMSM) from Asia (6). Migrants living in high-income countries are reported to have a lower self-perceived risk of HIV infection, language barriers, and concerns with confidentiality and privacy (7–10). Moreover, migrant GBMSM may face additional cultural and healthcare system barriers such as unfamiliarity with the local health system, distrust of health providers, and privacy concern, further hindering their access to HIV testing in conventional settings (11–13). Between 2014 and 2019, HIV diagnoses among Australian-born GBMSM declined by 44%, which likely occurred due to improved coverage of HIV testing and treatment, and implementation of PrEP across Australia (14). However, this success was offset by increased diagnoses among people born in other countries resulting in a relatively stable number of annual diagnoses overall (15). Surveillance data from 2018 suggest that migrant GBMSM in Australia are three times more likely to be undiagnosed for HIV and three times more likely to be diagnosed late than Australian-born GBMSM (14). Delays in testing lead to delayed treatment (16), and untreated HIV infections can disproportionately contribute to HIV transmissions (17–19). Together, this evidence underscores the urgent need to develop a better understanding of the needs of migrant GBMSM and improve access to earlier HIV testing, diagnosis, linkage to care, and bolster targeted prevention strategies. Medicare, Australia's universal health care scheme, is available to all Australian citizens and permanent residents. Medicare also covers temporary migrants from ten countries in Europe and New Zealand through reciprocal healthcare agreements (RHCA) (20). With access to Medicare, migrants from RHCA countries have full access to free HIV testing. In comparison, migrants from non-RHCA countries can access free testing through public-funded programmes that are unevenly distributed across Australia or private insurance, which may require reimbursable upfront payments (21, 22). Previous studies found that migrants ineligible for subsidised healthcare through RHCA were more likely to be diagnosed with HIV later than those born in Australia or countries covered by the RHCA agreement (23, 24). In addition, studies on HIV and hepatitis B virus care in Australia have demonstrated that the issue of ineligibility for subsidised healthcare places additional psychological and financial pressure on migrants (25, 26). HIV self-testing (HIVST) enables people to test for HIV conveniently and privately and is a promising tool to improve HIV testing uptake among migrant GBMSM (27, 28). Studies from several countries have confirmed that access to HIVST kits increases HIV testing uptake and frequency among GBMSM (29–32). More recently, HIVST kits have been successfully implemented in several countries to test underserved populations during the COVID-19 pandemic (33–35). To initiate or scale-up HIVST among GBMSM, various approaches to distribute HIVST kits have been evaluated globally, including through home delivery, pharmacies, vending machines, online purchasing, sexual or social networks, or social enterprise health campaigns—all of which have shown favourable outcomes (36–38). However, globally, little is known about the preferences of migrant GBMSM for accessing HIVST through these different channels. Discrete choice experiments (DCEs) are a methodology to understand user preferences for goods and services that are not yet widely available in the market (39). Within a DCE, individuals are asked to state their preference between different goods or services on offer, with each of the goods or services described by their underlying characteristics or attributes (40). Data from DCEs can be used to identify the trade-offs that individuals are willing to make between the attributes describing a good or service (41). This method has been widely employed to quantitatively estimate user and provider preferences towards HIV testing services in various settings (42–46). In this paper, we compare the preferences for HIV testing servi
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